Goal of treatment: Help to change maladaptive thoughts, feelings, behaviours

Helping Relationships: Most therapists today use an eclectic approach (A person who derives ideas, style, or taste from a broad and diverse range of sources.)

Psychodynamic Therapy

  • ASSUMPTIONS: Behavior is driven by biological urges, interpsychic conflict and developmental fixations
  • GOALS: client seeks insight regarding unconscious conflicts and motivations

METHODS:

  • Free association; dream interpretation, talking cure, catharsis
  • Transference; patient’s unconscious feelings about person in their life experienced as feeling toward therapist (therapist extract hidden motivations)
  • ***Time consuming as client must arrive at “insight”

Free Association

Not regular conversation!

  • Uncensored
  • Verbal reports of thoughts, feelings, or images that enter awareness without censorship
  • Can lead to important issues

Resistance: Defensive maneuvers that hinder process of therapy (unconscious)..sign that anxiety-arousing material is being approached

Transference: client responds irrationally to therapist like he/ she was important figure from the client’s past (brings out repressed feelings & maladaptive behaviours )

Two types of Transference

  • Positive: Feelings of affection, dependency, love
  • Negative: irrational expressions of anger, hatred, disappointment

Psychotherapy

Dream Analysis

  • Role of prior knowledge
  • Expectancies
  • Motivation
  • Emotion
  • Other top down processes

**However if the therapist has prior knowledge about a client might prompt a very different conclusions about the meaning of a dream content

  • Conclusions about client is based on a series of dream rather than just one
  • Seek to combine assessment info from various sources (test..interviews)

Brief Psychodynamic Therapies

  • Briefers, more economical
  • Focus on maladaptive past influences
  • Employ psychoanalytic concepts in a more focused and active fashion
  • Dream Interpretation: Therapists helps client understand the symbolic meaning of their dream

Interpersonal Therapy

  • Focuses almost exclusively on client’s current relationships with important people in their lives

HUMANISTIC THERAPY

ASSUMPTION: Everyone posses inner resources for self-healing

GOALS: tom promote personal growth and self-actualization/ to help client become aware of their own feelings and wishes and to gain control of their lives (for present and future, not past)

METHODS

  • Client-centred: therapists is a sounding board for clients thoughts
  • Reflection: Therapists repeats client’s concerns in order to help clients clarify feelings
  • Empathy: Therapist repeats client’s concerns in order to help client clarify feelings
  • Unconditional Positive Regard: safe, non-judgmental atmosphere in which client is worthy and capable

GESTALT THERAPY

  • GOAL: brings feelings, wishes, and thoughts into immediate awareness (awareness makes client “whole” again
  • METHOD: often carried out in groups, more active and dramatic, role-play

Does it work?

  • Empty Chair Technique: Converse with “chair”, client plays both roles, can reveal intense emotions, clients can successfully resolve past conflicts

COGNITIVE THERAPY

  • ASSUMPTIONS: Behaviour is controlled by Habitual ways of thinking
  • GOALS: to replace maladaptive way of thinking with adaptive ways of thinking about events related to self

METHODS

  • Problem-centred: focused on client’s specific problems
  • Thought stopping, recording automatic thoughts, refuting negative thinking, reattributions, homework assignments
  • RET: Rational Emotive Therapy (ELLIS)
  • Beck’s Cognitive Therapy: counteract negative thoughts about self and world

Beck’s Cognitive Therapy

  • Introduction to irrational beliefs
  • Ferret out ideas that underlie maladaptive emotional response
  • Point out errors of thinking
  • Help clients identify & reprogram their “automated” thought patterns
  • Major contribution to depression & self-instructional training!!

Ellis’ Rational Emotive Therapy

  • Activating Events
  • Belief system
  • Consequences (emotional & behavioral)
  • Disputing or challenging maladaptive emotions/ behavior

Behavior Therapies

  • Maladaptive behaviors are the problem, not a symptoms
  • Problem behavior are LEARNED
  • Maladaptive behaviors CAN BE UNLEARNED (through classical and operant conditioning, and modeling)

BEHAVIOUR THERAPY

  • ASSUMPTION: Maladaptive behaviours are acquired through learning
  • GOALS: to replace maladaptive ways of behaving with adaptive ways of coping

METHODS

  • Classical Conditioning: exposure treatment, client repeatedly exposed to threatening stimulus, systematic desensitization: gradual exposure treatment , flooding: abrupt exposure, aversive conditioning (e.g Antabuse)
  • Behaviour Modification: based on OPERANT CONDITIONING; reward desired behaviours and punish unwanted behavior (i.e token economies) modeling: client’s models therapist’s actions

Classical

  • Exposure: Classical conditioning; treat phobias though exposure to feared CS in the absence of UCS
  • Flooding: exposed to real-life stimuli
  • Implosion: imagine scenes involving stimuli
  • Exposure: highly effective for extinguishing anxiety responses (i.e Virtual Reality being used successfully used to treat Phobias & PTSD
  • Systematic Desensitization: learning-based treatment for anxiety disorders…eliminates anxiety though counter conditioning
  • Steps: train muscle relaxation skills (anxiety & relaxation cannot co-exist)..stimulus hierarchy..low-anxiety to high-anxiety scenes
  • Relaxation & Progressive (association with stimulus hierarchy)
  • In-Vivo Desensitization: controlled exposure to “real life” situations, creates more anxiety (see pic of what you fear, then movie, then model of it, then actual thing) during treatment than systematic sensitization, anxiety may reduce more though
  • Aversion Therapy: condition an aversion to a CS (e.g alcoholic drink) CS paired with noxious UCS

Operant Conditioning (Behaviour Modification) Treatments

  • Use reinforcement (pos. or neg.)
  • Or Punishment
  • Attempt to increase or reduce behavior
  • Successful when traditional therapies are difficult to implement (e.g behavior disorders, and profoundly disturbed children)

Modelling & Social Skills Training

  • Modeling approach
  • Learning of new skills by observing and imitating a model who performs a socially skillful behavior
  • Key Factors: increased self-efficacy, believe you can-you succeed! Watching someone else= I can do that too!

Cognitive Behavioural Therapy

  • Uses both cognitive and behavioural approaches
  • Correct: faulty behaviours and faulty cognitions
  • Quite effective for anxiety and mood disorders

Therapy Effectiveness

Dode Bird Verdict: “everyone wins”..similar efficacy found for widely differing therapies

How effective is therapy?

  • People tend to improve REGARDLESS!
  • People often seek help at worst times, any treatment is better than no treatment
  • A Caring Therapist is ESSENTIAL
  • Confession: a good for the sprit..some support the idea of catharsis

Effective Therapy Outcomes

  • Degree of value similarity between therapists & client
  • Feeling of ease with therapist methods
  • Explicit, agree-upon goal, and technique for the treatment
  • People should no longer fir the DMS criteria for the mental illness

Drug Therapies: Psychopharmacology (study how drugs affect cognitions, emotions, behavior

Psychologists DO NOT write prescriptions

Drug Therapy: Anti-anxiety, Antidepressant, Antipsychotic

Anti-anxiety: Tranquilizers, Barbiturates (drugs like Valium, ^GABA [inhibitory neurotransmitter] ***Useful for generalized anxiety**** doesn’t seem to help with phobias, OCD or panic disorders

  • Danger of overdose, suicide, addictive (psychological & physiological)
  • Designed to reduce anxiety without affecting alertness or concentration
  • Slows down excitatory synaptic activity (causes drowsiness, lethargy dependence)
  • NEWER Drugs: Buspirone (BuSpar) enhances inhibitory neurotransmitter GABA [LESS SIDE EFFECTS/ ABUSE]

Antidepressants

Tricyclics

  • Prevent reuptake of excitatory neurotransmitters
  • Increase activity of norepinephrine & serotonin

Monoamine Oxidase (MAO) Inhibitors

  • MAO break down neurotransmitters (MAO inhibitors) inhibit this process
  • Increase activity of norepinephrine & serotonin
  • Neurotransmitters that help relay message from one area of the brain to another…influence mood, sexual desire, appetite, sleep, memory

Serotonin & Depression

  • Possible low production of serotonin
  • Lack of receptors sites
  • Inability of serotonin to reach receptors sites
  • New theory: Serotonin -> Regeneration of brain cells -> cure depression

Selective Serotonin Reuptake Inhibitors (SSRIs)

  • E.g Prozac, Zoloft, Paxil
  • 2nd generation of antidepressants
  • Blocks the reuptake of serotonin (little effect on other transmitters
  • Milder side effects that other antidepressants
  • Reduce depressive symptoms more rapidly
  • Originally for depression, now marketed for OCD, social phobia
  • MOST FREQUENT LY PRESCRIBED PSYCHOACTIVE DRUGS IN THE US

3 groups of Antidepressants medications

  • Tricyclics
  • MAO inhibitors
  • SSRI’s
  • Bipolar medication (manic plus depression)
  • Lithium: evens out mood swings in both direction (not just for acute manic attacks)
  • Tegretol: (& other anticonvulsants) works for those who cycle between mania & depressions over the course of hours or days (rather than months)

Depression & Sleep

Possibility of TOO MUCH REM sleep (either short REM latency or quick to get REM and then a long period of REM or lost of REM

TOO LITTLE SLOW-WAVE SLEEP (in cats, 20 different antidepressants drugs; all reduced REM and increased slow-wave sleep)

Antipsychotic drugs= Major tranquilizers

e.g chlorpromazine

  • Decrease action of dopamine by blocking receptors (dopamine hypothesis) of schizophrenia (overactivity)
  • Reduce positive symptoms of schizophrenia (delusions and hallucinations
  • Little effect on negative symptoms
  • Side effect: can produce tardive dyskinesia Irreversible (?) severe movement disorder
  • Second generation antipsychotic: fewer side effects, needle give by doctor; biweekly..little tradive dykinesia…helpful with positive as well as negative symptoms
  • Newer Generation Antipsychotics: affects dopamine plus other NTs, may help negative symptoms, no motor side effects, risk of serious blood disorder
  • Drug treatments: is taking Valium for anxiety similar to taking Tylenol for fever?
  • Do not teach client coping & problem solving skills to deal with stress
  • Can bring symptoms under control & other therapeutic techniques can incorporated

Two Major Approaches

  • Psychological Treatments: “Its your life/ behavior/ reaction” Psychotherapy
  • Biological Treatments: “Biological Treatments” Psychopharmacology, Electroshock Therapy, Psychosurgery

Electroconvulsive Therapy (ECT)

  • Began with observation that schizophrenia & epilepsy rarely occur together
  • ECT induces seizure in anesthetized parents

Procedure

  • Patients given sedative and muscle relaxant
  • Placed on well-padded mattress
  • Shock less than 1 second, causing seizures of CNS
  • Last resort for severe depression but often works [70% success rate, success can be immediate]
  • Possible memory & cognitive problems
  • Has become more humane over year (i.e anesthesia, muscle relaxants, unilateral stimulation to reduce, retrograde memory loss)

Transcranial Magnetic Stimulation (TMS)

  • Magnetic field create a weak electrical current in a focal part of the brain
  • Stimulates brain neuronal activity (very weak and no seizures activity
  • Repetitive TMS (rTMS)
  • Effective for alleviated depression
  • Especially rTMs to Left frontal love
  • Responsible for mood regulation

Psychosurgery – method of last resort

Procedures that remove or destroy parts of the brain (least used of biomedical procedures)

Lobotomy

Destroy nerve tracts to frontal lobes (Dr. Moniz won Nobel Prize (1949)…decreased with advent of antipsychotic

Cingulotomy

Cut fibers that connect frontal loves & limbic system..useful in severe depression & OCD

Deep Brain Simulation (DBS)

  • Fine wires inserted into brain and threaded down to thalamus
  • Low current sent through wires stimulating the thalamus and “awakening” higher brain
  • Battery pack and charging unit implanted under the skin of the best

Mind, Body & Intervention

Both psychological & biological treatments affect brain functioning

PET scans: BOTH psychotherapy & drug therapy (showed similar changes in blood flow 3 brain areas)

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